Efficacy and Mechanisms of a Metacognitive Strategy Intervention for Parkinson disease-related Cognitive Decline

PROJECT SUMMARY/ABSTRACT The long-term goal of this research is to reduce disability, improve quality of life, and delay dementia onset among people with Parkinson disease (PD) by enabling them to cope with cognitive decline so they can perform and participate in meaningful activities and roles. Cognitive impairment is one of the most common and disabling features of PD and is a major management challenge and area of unmet need. Surgical and pharmacological treatments have proven largely ineffective in addressing this pressing burden, so behavioral interventions that attenuate the negative functional consequences of PD-related cognitive decline are a top research and clinical priority. Unfortunately, the widely used cognitive training approach to cognitive intervention (repetitive practice of tasks designed to challenge and improve specific cognitive functions) has been unsuccessful in improving daily function and quality of life in people with PD. To overcome this limitation, the investigators take a strategy training approach, teaching targeted strategies that people can use in their everyday lives to circumvent cognitive deficits and accomplish daily tasks. Strategy training is a practice standard for cognitive rehabilitation in brain injury and stroke, but its application in PD is novel. Moreover, the strategy training intervention used in this study, the Multicontext (MC) Approach, explicitly focuses on generalization of training to daily function, an aspect that is critically lacking from PD-related cognitive intervention research to date. Through rigorous and systematic development and pilot testing, the investigators have fully specified and manualized the MC Approach, developed therapist training procedures, and shown that is acceptable to participants, feasible to administer with high fidelity in real-world treatment settings, and associated with clinically meaningful improvements in daily cognitive function. The primary objective of the current project is to determine the efficacy of the MC Approach for improving daily cognitive function in people with PD and mild cognitive decline. It is an assessor-blind randomized controlled trial comparing the short-term and long-term effects of the MC Approach to a traditional cognitive task training approach on personalized functional cognitive goals (Aim 1). Additional aims are to examine whether booster treatment enhances MC Approach treatment effects (Aim 2) and explore the cognitive-behavioral mechanisms of the MC Approach (Aim 3). This work will meet the pressing need for evidence-based and implementable interventions that reduce functional impairment associated with PD-related cognitive decline and potentially delay dementia onset in this population. Ultimately, it will improve clinical care for the growing number of people living with PD and reduce the socioeconomic burden of this disease.